Overview: The goal of this career development award is to provide Yelena Wu, PhD, with training and mentored research experiences that will facilitate her transition into being an independent investigator in cancer prevention among high-risk children. Her long-term goal is to become an expert in integrating genetic risk communication techniques into family-focused behavioral interventions targeting children at high hereditary risk for cancer in order to advance cancer prevention, early detection, and prediction of clinical outcomes. Research: Melanoma is a common form of cancer that is associated with significant morbidity and mortality. Advances in genetics and genetic testing now allow us to identify individuals who are at particularly high risk for developing melanoma. Specifically, we can now identify children who carry the CDKN2A/p16 genetic mutation that places them at up to a 70-fold increased risk for melanoma and a predisposition to developing it at an earlier age. While genetic risk cannot be altered, children's risk for melanoma can be mitigated by implementing preventive behaviors that minimize severe sunburns, a primary risk factor for melanoma, and creating lifelong habits that include skin self-examinations to promote early detection. Unfortunately, individuals at high hereditary risk for melanoma, including children, have suboptimal adherence to preventive and screening behaviors, such as regular use of sunscreen or physical barriers and performance of skin self- examinations. Furthermore, there are no translational and comprehensive behavioral interventions that incorporate genetic testing results for at-risk children and target adherence to multiple melanoma preventive behaviors among these children. The proposed research will lead to the development of a family-focused behavioral intervention to improve adherence to melanoma preventive behaviors among children at high hereditary risk for melanoma. The proposed research will include three studies. Study 1 (analysis of newly- available data from the first prospective, longitudinal study of melanoma genetic testing of children and adolescents) and Study 2 (focus groups) will identify modifiable factors that influence melanoma preventive behaviors among high-risk children and parents that can be targets of intervention. Study 3 will involve the iterative development and pilot-testing of a family-focused behavioral intervention that incorporates genetic risk communication and aims to improve adherence to melanoma preventive behaviors. The content and format of the intervention will be optimized using the findings of Studies 1 and 2. The primary outcomes will be the intervention's feasibility and acceptability, as well as children's preventive behavior adherence. Preventive behavior adherence will be assessed pre-intervention, post-intervention, and at one follow-up assessment using both self-report and objective methods. Objective measures of ultraviolet radiation exposure will include ultraviolet radiation dosimetry and reflectance spectroscopy. Findings from these studies could inform the integration of genetic risk information with preventive behavior recommendations to children at high risk for cancer. The proposed research will prepare Dr. Wu to apply for R-level funding to further examine the impact of genetic testing and risk communication with children and their parents and to conduct a fully powered test of the behavioral intervention developed through this K07. This career development award will enable Dr. Wu to become one of the few behavioral experts in cancer prevention among high-risk children to guide this area of clinical care. Career Development Plan: Dr. Wu is a pediatric psychologist with a strong foundation in pediatric adherence to medical regimens and implementation of behavioral interventions for children who are currently ill. The K07 coursework, targeted training, seminar attendance, and mentored research experiences will provide the skills and experiences Dr. Wu needs to become an independent investigator in cancer risk communication and prevention in genetically at-risk families. During the 5-year training period, Dr. Wu will acquire new content area knowledge in cancer genetics, genetic risk communication with application to families, and decision- making. She will also gain new skills in qualitative, patient-centered approaches to designing preventive behavioral interventions. Together with her co-mentors, Dr. Wu has assembled a highly experienced and internationally-recognized mentoring team. The mentoring team members will provide guidance in the complementary areas of genetic testing, genetic risk communication, melanoma predisposition, behavioral oncology clinical trials, qualitative methodology, and development of behavioral interventions for cancer prevention. The Huntsman Cancer Institute, an NCI-designated Cancer Center, and the University of Utah provide superb environments for the career development of junior faculty and unparalleled opportunities for multidisciplinary research collaborations in cancer genetics. Unique, on-site resources that will be used for Dr. Wu's K07 training and research include the Huntsman Cancer Institute's Genetic Counseling Shared Resource and the University of Utah Genetic Science Learning Center.